Legislative basis for certification and licensing of medical workers. The system of postgraduate medical education in Russia

Medical institutions and individuals must be accredited and have a certificate to engage in the relevant activity.

Accreditation (from lat. accredo - I trust) of institutions and persons is the determination of the compliance of their activities with established standards for the provision of medical care and services in accordance with the order of the Ministry of Health of Russia dated March 2, 1999 No. 70 "On Licensing and Accreditation of Medical Institutions".

Accreditation is carried out by accreditation commissions created from representatives of health authorities, professional medical associations and insurance companies. medical organizations on republican (for republics in the composition Russian Federation), territorial (territorial, regional or autonomous entities) and city (Moscow and St. Petersburg) levels.

Financing of accreditation commissions is carried out at the expense of payment for accreditation procedures, dispute resolution or from other sources not prohibited by the laws of the Russian Federation.

Control over the activities of the accreditation commission is entrusted to the bodies government controlled. The accreditation commissions consist of administration, commission members and contracted experts. The general management of the commission is carried out by the chairman, who is elected at a meeting of the commission for a period of 3 years (no more than two terms in a row) from among the members of the commission by secret ballot by a simple majority of votes and approved by the government body. Experts are highly qualified specialists in various types medical activities.

Accreditation of institutions and persons is carried out by accreditation commissions, which are provided with a list of documents in the prescribed manner. Terms of accreditation and tariffs are established by regional government bodies. The validity period of the certificate should not exceed 5 years, but at the initiative of a medical institution or association or by a court decision, accreditation can be carried out earlier.

Accredited institutions and persons receive a certificate that confirms the degree of compliance of the declared types of medical care or services in full. The experts involved by the commission are guided by the legislation of the Russian Federation and, first of all, by Decree of the Government of the Russian Federation of May 21, 2001 No. 402 "On Approval of the Regulations on Licensing Medical Activities" (as amended on August 10, 1998). The result of their examination is the conclusion.

The above Regulation sets out the rights and obligations of accredited institutions and persons.

Accredited institutions and individuals are entitled to:-

receive information about the procedure and terms of accreditation; -

change the terms of accreditation; -

invite independent experts; -

re-accreditation; -

in case of disagreement with the decision of the commission, appeal it through the court.

Institutions and individuals are required to:-

in deadlines apply for accreditation; -

be responsible for the information provided in the documents; -

pay for accreditation and submit a payment receipt; -

provide conditions for the examination; -

provide representation at the meeting of the accreditation commission.

For accreditation by a medical institution, the following documents are submitted: -

statement; -

registered charter of a medical enterprise (institution); -

memorandum of association (copy) or agreement on joint activities with a government body (for institutions with state form property); -

a copy of the order or contract for the lease of premises; -

copies of certificates and licenses previously issued to the institution; -

copies of certificates of employees ensuring the performance of the declared types of activities; -

certificate of premises, equipment (separately by type of activity and for the entire enterprise as a whole); -

the number of employees, their qualification characteristics; -

indicators of the volume of activities performed at the time of application; -

financial report for the last year (balance sheet); -

the presence of administrative and disciplinary actions for any activities in the last year; -

documents on participation in the implementation of territorial medical programs; -

materials on the analysis of the quality of medical care in accordance with the territorial quality control system; -

documents on the scientific activity of the enterprise (institution); -

documents confirming pedagogical activity.

The following documents are submitted for accreditation by a doctor or other healthcare professional: -

statement; -

a copy of the diploma of graduation from a medical school; -

a copy of the certificate of advanced training and specialization (including in the workplace); -

a copy of the diploma of the candidate, doctor medical sciences, associate professor, professor; -

a report on the activities of the doctor indicating the list, volumes and types of medical work performed (not certified); -

types of medical activity declared for accreditation; -

a copy of previously issued certificates; -

the presence of disciplinary and administrative penalties for any types of medical activities for the last year; -

participation in the implementation of territorial medical programs; -

scientific activity (list of works, speeches at scientific conferences participation in the work of scientific societies, etc.

pedagogical activity (including part-time work and on-the-job training); -

extract from work book.

Licensing of medical institutions is necessary, as it is one of the conditions for the legal functioning of a medical institution, organization or enterprise, regardless of the healthcare system.

In accordance with Art. 15 Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens and Decree of the Government of the Russian Federation dated May 21, 2001 No. 402 "On Approval of the Regulations on Licensing Medical Activities" licensing of medical activities is carried out by the executive authority of the subject of the Russian Federation located on the territory of this subject. If it is necessary to operate in other regions, registration of such a license is obligatory by the executive authority of the constituent entity of the Russian Federation. This applies to healthcare facilities, university clinics and research institutes. The composition of the licensing commission of the state administration body of the constituent entity of the Russian Federation includes its representatives or local administration, health authorities, professional medical pharmaceutical associations.

The commission determines the validity period of the license, but not more than 5 years for public institutions and no more than 3 years for institutions with non-state forms of ownership. Licensing provides for the study of the documents submitted by the institution, the conduct of an examination on the ground and the issuance of a license for the right to provide medical care in the declared volume, with restrictions, or a justified refusal to issue a license.

Health authorities, medical and pharmaceutical institutions, organizations, professional associations may apply to the licensing commission for extraordinary licensing, as well as for the withdrawal or suspension of a license if non-compliance with the requirements of the quality standard of medical care is revealed. As for licenses for the activities of medical educational institutions, higher and secondary educational institutions, as well as postgraduate education, they are issued by the Ministry of Education of the Russian Federation.

Medical institutions submit the following documents to the licensing commission: -

statement; -

a copy of the charter or regulation of the licensed institution, approved in the prescribed manner; -

a copy of the order or agreement on the lease of premises, documents confirming the availability or the possibility of legal use of premises, tools, equipment corresponding to the requested types of activity; -

types of medical activities, services, insurance programs declared for licensing; -

copies of certificates previously issued to the institution; -

the conclusion of the state sanitary supervision; -

the conclusion of the state fire supervision; -

safety report; -

conclusion on the operation of the building; -

financial report of the institution for the last year; -

annual report of the institution for the last 3 years.

The licensed institution has the right to:-

get everything necessary information and documents on the procedure for licensing; -

re-licensing; -

increase the terms of licensing; -

challenge the decision of the territorial licensing commissions in the republican commission; -

accept for licensing independent experts with advisory voting rights.

The licensed institution is required to:-

timely submit an application and documents for licensing; -

be responsible for the truthfulness of the information contained in the submitted documents; -

confirm payment and provide conditions for licensing; -

ensure the attendance of representatives of institutions at the meeting of the licensing commission.

The certificate confirms the certification of a specialist. It is issued on the basis of postgraduate vocational education(internships, clinical internships, postgraduate studies), as well as doctors with experience - additional education in advanced training courses and faculties with a subsequent verification test.

As you know, a certificate is issued for the declared types of activities (and in this it is similar to a license) for certain types of medical or pharmaceutical activities in accordance with the Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens. This is noted in the letter of the Ministry of Health of Russia "On the clarification of the order of the Ministry of Health of Russia dated 07.08.95 No. 15-00 "On approval of the Regulations on the procedure for admission to the implementation of professional (medical or pharmaceutical) activities."

The procedure for admission to the implementation of medical activities is set out in a number of documents. These include the Regulations on the final state certification of graduates of higher educational institutions in the Russian Federation, approved. resolution State Committee of the Russian Federation on higher education dated 05.25.94 No. 3, order of the Ministry of Health of Russia dated 31.03.97 No. 3 "On the phased introduction since 1997 of the final state certification of graduates of higher medical and pharmaceutical educational institutions", as well as letter of the Ministry of Health of Russia dated 15.06.00 No. 2510-6646 "On the final state certification of graduates of higher medical and pharmaceutical educational institutions."

The mentioned letter gives the stages of certification, the list and form of exams and, importantly, qualification characteristics, a list of knowledge and skills for graduate doctors in the specialties: "medical business" (040100), "pediatrics" (040200), "medical and preventive work" (040300), compiled on the basis of the state standard.

After passing the mandatory primary one-year postgraduate training (internship), the doctor must prove that his professional education complies with the state standard, the official certificate of which is a specialist certificate. For higher medical education, state standards were approved by the State Committee for Higher Education of Russia on the basis of Decree of the Government of the Russian Federation of August 12, 1994 No. 940 "On Approval of the State Educational Standard of Higher Professional Education" in accordance with standard plans and programs reviewed every 5 years.

To obtain a certificate, a doctor, after completing an internship, residency or postgraduate course, takes a qualifying exam, for which the Ministry of Health of Russia has specially developed test programs for specialties, and receives a certificate or certificate. The specialist certificate is renewed every 5 years. Documents on the completion of internship, residency and postgraduate studies issued before 5 years have equal legal force with the certificate.

According to Art. 60 "Doctor's Oath" of the Basic Laws of the Russian Federation on the protection of the health of citizens, persons who have graduated from higher medical educational institutions in Russia take an oath before receiving a doctor's diploma. IN federal law dated December 20, 1999 No. 214-FZ "On Amendments to Article 60 of the Fundamentals of Legislation of the Russian Federation on the Protection of Citizens' Health", for the first time after the adoption of the new Constitution of the Russian Federation, the text that is given above was published.

Doctors for violation of the doctor's oath are liable under the legislation of the Russian Federation.

Certification of doctors, pharmacists, other specialists with higher education is carried out in accordance with the order of the Ministry of Health and Medical Industry of Russia dated February 16, 1995 No. 33 "On approval of the Regulations on the certification of doctors, pharmacists and other specialists with higher education in the healthcare system of the Russian Federation" (as amended on September 28, 1999) and the order of the regional health department, which form composition of the certification committee. The commission is headed by the chairman, he determines the rules of its work (Appendix 1 to the mentioned order). The commission consists of a secretary and members from among highly qualified specialists, scientists and medical practitioners. The form of work of the commission is meetings held according to the schedule approved by the head of the health management body. Members of the commission get acquainted with the submitted materials 10 days before the meeting. The decision is taken by open voting by an absolute majority of votes and is valid throughout Russia. The chairman of the profile subcommittee takes part in the meeting of the commission.

A preliminary test of theoretical knowledge and practical skills is carried out by computer testing, taking into account the assimilation of practical skills, solving situational problems and the results of an interview in a subcommittee. The head of the health management body approves the number and composition of the subcommittee, its chairman and the secretary who manages office work. The subcommittee meets as cases accumulate. A decision of a recommendatory nature is made by open voting by an absolute majority of those present based on the results of computer testing and an interview that determines the level of theoretical knowledge and the amount of practical skills, the quality and reliability of the report presented.

A specialist who has expressed a desire to undergo certification submits a personal statement; when confirming a previously assigned category - no later than three months before the expiration of its term; certification sheet and report on work for the last 3 years. The report should cover the nature of the doctor's activities, the performance of the department or health facility, its characteristics, the dynamics of indicators for 3 years and an assessment of existing trends compared to the corresponding indicators of the city or district. The report is accompanied by published articles, certificates for rationalization proposals, inventions, programs of conferences, congresses, improvement cycles in which the person being certified took part. The report is signed by the applicant and certified by the head of the institution.

The second category is assigned to doctors who have at least 5 years of experience in this specialty, the first - at least 7, the highest - at least 10 years. Work experience includes training in internship, clinical residency and postgraduate studies in the same specialty. In some cases, with high practical and theoretical training, a higher category can be assigned without established requirements to experience. Professionals who have degree doctor of medical sciences, the highest category is assigned in absentia. In case of refusal of a specialist from the next recertification, the previously assigned category is lost. Attestation is carried out for a fee at the expense of the assessed person, trade union, scientific society or association at officially established rates.

Certification is one of the mechanisms of state control over the quality of training of specialists, which is voluntary procedure and aims to stimulate the growth of staff qualifications.

Part attestation commission includes leading specialists of medical and preventive, research institutions, higher medical educational institutions, chief specialists of the health management body, representatives of professional medical associations.

The Ministry of Health of the Russian Federation, by its Order dated 09.08.2001, approved the Regulations defining the procedure for obtaining qualification categories by specialists working in the healthcare system of the Russian Federation. In accordance with this Regulation, when obtaining a qualification category, professional qualification, competence, as well as the ability of a specialist to perform job responsibilities according to the position.

The qualification of a specialist is determined by three qualification categories: second, first and highest.

To certification are allowed specialists with work experience in the certified specialty:

for the assignment of the highest category - 10 years, of which 3 years in one place

To pass certification (re-certification) for a qualification category, a specialist submits the following the documents:

1. Application

2. Attestation sheet

3. Report on work for the last three years, approved by the head of the medical institution

Attestation procedure represents the passing by a specialist of a qualification exam for the assignment qualification category. The attestation exam can take place both in the form of testing and in the form of an interview and is conducted by examination boards in specialties. Practical skills are assessed based on the submission of a work report from the main place of work for the last 3 years.

Assessment of qualifications and recommendations for further professional training of a specialist are adopted by voting in the presence of at least 2/3 of the number of members of the approved composition of the certification commission. The results are determined by a majority of votes, and in case of equality of votes, the decision is considered adopted in favor of the specialist.

The decision of the attestation commission is drawn up in a protocol, which is signed by the chairman, secretary and members of the commission who took part in the meeting. Then, the body under which the attestation commission is established, within one month, issues an order on the assignment of a qualification category, which is brought to the attention of the specialist and the head of the healthcare institution.

Recertification to confirm the existing category is carried out every 5 years. In case of refusal of a specialist from the next recertification, the previously assigned qualification category is lost from the moment of the expiration of the five-year period for its assignment.

Certification- a mandatory procedure for all categories of medical workers, since a specialist certificate is required to engage in professional (medical and pharmaceutical) activities.

Specialist Certificate- This is a document of a single sample, confirming the compliance of the training of a specialist with state educational standards. The result of obtaining a specialist certificate is the admission of a specialist to the implementation of professional medical activities. Persons who do not have a certificate can only work as trainees under the supervision of a certified specialist.

Personnel certification is carried out qualification commissions, which are created at state universities and scientific research institutes of a medical profile, as well as at professional medical associations.

Certification procedure is the process of passing a qualifying examination to obtain a specialist certificate. The qualification exam is conducted by examination commissions in specialties approved by the Ministry of Health of the Russian Federation.

To pass the qualifying exam, the medical worker provides the following documents:

1. Application

2. Copy of medical school diploma

3. Copies of documents state sample on the passage of various forms of postgraduate or additional professional education

4. Copies of previously issued certificates

5. Copy of work book

Exam includes three parts: test control, determination of practical skills, final interview.

The following medical workers are allowed to take the qualification exam for a specialist certificate:

1. Of the inexperienced professional activity - persons who have completed internship, residency, postgraduate studies in clinical disciplines

2. Of those with experience- specialists who have improved their qualifications in cycles of improvement in their specialty in licensed institutions over the past 5 years or who have completed doctoral studies in a clinical discipline.

Federal Agency for Health and Social Development"

Department of Public Health and Health with a PO course

METHODOLOGICAL INSTRUCTIONS

FOR STUDENTS

TO PRACTICAL LESSON FOR CLASSROOM WORK

4th year STUDENTS of the Faculty of Medicine

Topic #7:"Licensing and accreditation in the healthcare sector".

Approved at the cathedral meeting

(inter-departmental methodical conference)

Protocol No. 10

Head Department of OZiZ

GOU VPO KrasGMA Roszdrav

PhD Shulmin A. V. (signature) ……………………..

Compiled by:

PhD , Associate Professor Averchenko E.A.

Krasnoyarsk

1. Topic of the lesson: Licensing and accreditation in the healthcare sector.

2. The value of studying the topic:

Educational value: In the course of the lesson, students should learn the basic concepts. To master the methodology for calculating the LCL and their importance in assessing the quality of medical care. Know the main points related to the procedure for licensing and certification of medical institutions and employees.

Professional value: Knowledge of the methodology for calculating the UKL, the procedure for licensing and certification of medical institutions and workers is a necessary skill in the independent practice of a doctor at the present stage.

Personal value: Development of responsibility for the quality of medical and preventive services provided. Formation of an understanding of the importance of each medical worker in improving the quality of health goods and services.

3. Goals of studying the topic:

3.1. General goal: Training of a qualified specialist with knowledge and skills in the field of discipline “Public health and healthcare.

To achieve this goal it is necessary:

Know: The concept of quality. Quality standardization. Competitiveness and quality.

Be able to: Determine the level of quality of medical care provided to the patient

Have an idea: About the organization and procedure for conducting non-departmental quality control of medical care

Have skills:

Methods for calculating UKL,

The procedure for licensing and certification of medical institutions and employees.

4. Plan for the lesson

5. Basic concepts and provisions of the topic.

The procedure for licensing and certification of medical institutions and medical workers

Licensing of medical institutions

Since 1992, an important place has been given to licensing in the system of measures of state regulation of medical and pharmaceutical activities. License (from Latin licentia - freedom, right) - a special permit to carry out a specific type of activity subject to the obligatory observance of licensing requirements and conditions, issued by the licensing authority to a legal entity or individual entrepreneur (Article 2 of the Law on Licensing Certain Types of Activities).

Organizational structure of licensing authorities in the health care system and social development, as well as the regulatory framework governing licensing issues, began to be created in 1992. Their formation took place in the new political and economic conditions. It was necessary to develop a mechanism of state regulation, fundamentally different from the mechanism that operated before 1991. Thirteen years of experience in the application of the mechanism of state regulation showed that licensing is an effective lever in the system of measures of state supervision and control.

Licensing is associated with the restriction of the rights of a legal entity or an individual entrepreneur to carry out certain actions in licensed activities. In the conditions of market relations, this restriction should have a legislative basis and a clear argumentation. The powers to restrict certain actions are vested in state executive bodies that carry out licensing.

In accordance with the Decree of the President of the Russian Federation of March 9, 2004 No. 314 "On the system and structure of federal executive bodies," a large-scale administrative reform began to be implemented. Significant changes have taken place in the functions and powers of most federal executive bodies.

New federal executive bodies have been formed - federal ministries, federal services and federal agencies. They have become new not only in name, but also in terms of tasks, functions and powers assigned to them.

Decrees of the Government of the Russian Federation of June 30, 2004 No. 323 "On approval of the Regulations on the Federal Service for Supervision in the Sphere of Health and Social Development" and of August 12, 2004 No. 412 "On licensing activities related to the circulation of narcotic drugs and psychotropic substances" licensing of all types of activities in the field of healthcare and social development is entrusted to the Federal Service for Supervision of Health and Social Development (Roszdravnadzor). The Licensing Department was created within the structure of Roszdravnadzor. For each licensed type of activity, the orders of Roszdravnadzor created central commissions for licensing and approved the relevant regulations on their work.

The commissions, along with employees of Roszdravnadzor, included representatives of other ministries and departments: the Ministry of Internal Affairs of Russia, the Federal Drug Control Service of Russia, the Ministry of Industry and Energy of Russia, the Federal Service for Intellectual Property, Patents and Trademarks (Rospatent), the Federal Service for Supervision of Consumer Rights Protection and Human Welfare ( Rospotrebnadzor), as well as health authorities of the constituent entities of the Russian Federation, professional medical and pharmaceutical associations, scientific and educational institutions, government agencies in the field of licensed activities.

Licensing in the field of health and social development has two fundamental features.

The criteria determining the licensing of activities in this area are related to the state of health of citizens. In these types of activities, the state interacts with each other in the person of federal and regional bodies executive power and numerous subjects of the pharmaceutical market, the market of medical and social services. These include manufacturers of medical devices, distributors, doctors, pharmacists, pharmacy chains, state and municipal medical institutions, pharmacy institutions and private enterprises, social security institutions, representatives of private domestic and foreign capital and society represented by consumers in need of medical, medicinal and social assistance.

Another feature is the pronounced social significance of the types of activities for which it is necessary to obtain a license. The mechanism of licensing as an element of state regulation of relations in a limited number of activities is based on legislative and by-laws developed on their basis. Departmental regulations, as a rule, specify (establish) the requirements and conditions of the licensed type of activity.

The legal bases for licensing in the field of healthcare and social development are:

1. The Constitution of the Russian Federation (RG. 1993. No. 237). The state guarantees the implementation of the general norm of paragraph 3 of Art. 17 of the Constitution of the Russian Federation, which establishes that the exercise of human and civil rights and freedoms, including the right to engage in entrepreneurial and other economic activities not prohibited by law, must not violate the rights and freedoms of other persons. Paragraph 1 of Art. 34 of the Constitution of the Russian Federation grants everyone the right to freely use their abilities and property for entrepreneurial and other economic activities not prohibited by law. In accordance with paragraph 3 of Art. 55 of the Basic Law, this right may be limited only by federal law and only to the extent necessary for the following purposes:

protection of the foundations of the constitutional system;

protection of morality, health of other persons;

protection of the rights and legitimate interests of these persons;

ensuring the defense of the country;

ensuring the security of the state.

2. Civil Code Russian Federation (GK RF) (SZ RF. 1994. No. 32. Art. 3301). Paragraph 1 of Art. 49 of the Civil Code of the Russian Federation it is established that a legal entity can engage in certain types of activities, the list of which is determined by law, only on the basis of a special permit (license).

3. Federal Law No. 128-FZ of 08.08.2001 "On Licensing Certain Types of Activities" (SZ RF. 2001. No. 33 (Part I). Art. 3430).

4. Federal Law of December 23, 1995 No. 26-FZ "On natural healing resources, health-improving areas and resorts" (SZ RF. 1995. No. 9. Art. 713).

5. Federal Law No. 122-FZ dated August 22, 2004 “On Amending the Legislative Acts of the Russian Federation and Recognizing Some Legislative Acts of the Russian Federation as Invalid in Connection with the Adoption of Federal Laws “On Amendments and Additions to the Federal Law “On the General Principles of Organization legislative (representative) and executive bodies of state power of the constituent entities of the Russian Federation" and "On the general principles of the organization of local self-government in the Russian Federation" (SZ RF. 2004. No. 35. Art. 3607).

6. Decree of the Government of the Russian Federation of 04.07.2002 No. 499 "On approval of the Regulations on the licensing of medical activities" (SZ RF. 2002. No. 27. Art. 2710).

7. Decree of the Government of the Russian Federation of June 30, 2004 No. 323 "On approval of the Regulations on the Federal Service for Supervision in Health and Social Development" (RG. 2004. No. 144).

Basic Licensing Principles

The basic principles of licensing in our country are set out in the Federal Law of 08.08.2001 No. 128-FZ "On Licensing Certain Types of Activities". First of all, it is:

unity of the economic space;

establishment of a unified licensing procedure;

establishing licensing requirements and conditions;

publicity and openness of the procedure;

compliance with the law in the implementation of licensing.

Scheme of the organization of licensing in the field of healthcare and

social development

In accordance with the Regulations on the Federal Service for Supervision in Health and Social Development, approved. By Decree of the Government of the Russian Federation No. 323 dated June 30, 2004, Roszdravnadzor is entrusted with the functions of licensing medical, pharmaceutical activities, the production of medicines and medical equipment, prosthetic and orthopedic care, as well as activities related to the circulation of narcotic drugs and psychotropic substances.

Functions of Roszdravnadzor (in terms of licensing):

issuance of licenses for conducting medical, pharmaceutical activities, production of medicines and medical equipment, as well as for conducting activities related to the circulation of narcotic drugs and psychotropic substances, and activities for the provision of prosthetic and orthopedic care;

maintaining a register of licenses for these types of activities;

methodological guide on licensing issues;

control over the activities of institutions and organizations in terms of compliance with license requirements and conditions. It should be especially noted that, in accordance with the Regulations on the Federal Service for Supervision of Health and Social Development, Roszdravnadzor licenses medical institutions, organizations and enterprises, pharmaceutical activities of pharmacies and enterprises, as well as enterprises of the medical and pharmaceutical industries throughout the Russian Federation.

The scheme for organizing licensing in the field of healthcare and social development includes Roszdravnadzor, its territorial bodies, central commissions for licensing types of activities, as well as commissions of the Federal Service for Supervision in Healthcare and Social Development for licensing medical and pharmaceutical activities in the constituent entities of the Russian Federation.

Roszdravnadzor retains the functions of supervising the activities of all licensees and license applicants without exception, assumes obligations to conduct seminars and train members of licensing commissions, as well as experts on organizing licensing work and assessing the quality of medical and social care.

The assessment of licensed medical activities is carried out for compliance with licensing requirements and conditions (clause 4 of the Regulations on Licensing Medical Activities, approved by Decree of the Government of the Russian Federation of 04.07. implementation of medical activities.

The main principles of expert activity are:

compliance of the estimated parameters with the regulatory legal framework;

use of approved clinical standards and protocols;

unification of requirements regardless of the organizational and legal form;

independence, competence, objectivity.

An expert may be a person (a specialist of the licensing authority, a freelance expert) with a higher specialized education, having at least 10 years of experience in healthcare, a qualification category (first or higher) or an academic degree, as well as who has received training in licensing expertise and is included in the register of experts on licensing medical activities.

Examination during licensing is an assessment of the structure of the applicant as one of the factors affecting the quality of medical services. The following are considered: the level of organization of the work of the manager and the staff as a whole; organizational and technical capabilities: safety conditions in the implementation of activities, qualifications medical personnel, buildings, structures, premises, security, condition and maintenance of medical, auxiliary and organizational equipment, resource provision, use and correctness of maintenance medical records.

To unify the work, a number of documents have been developed in accordance with the current legislation of the Russian Federation:

the form of the inventory of documents submitted for obtaining a license;

application form for licensing;

the form of the declared works and services indicating the relevant codes for the nomenclature of works and services for the provision of appropriate medical care;

form of information on professional training in accordance with each declared type of work and services;

a form of information on the provision of medical equipment, apparatus, tools, etc. in accordance with the declared types of work and services.

For unified approaches to assessing compliance with license requirements and conditions, the following have been developed:

a form of conclusion on the compliance of the license applicant with licensing requirements and conditions (during examination at the place of business);

form of conclusion on the compliance of the license applicant with the licensing requirements and conditions (filled in by the expert during the examination of documents);

forms of expert opinions on the range of works and services of each section of medical care (pre-hospital, outpatient, inpatient, ambulance and emergency, sanatorium and resort).

All schemes of conclusions are divided into two parts: ascertaining and final-recommendatory, containing a summary for the Commission on Licensing Medical Activities.

After submitting the application of the applicant with the attachment of all the documents stipulated by the legislation ("licensing file"), the licensing authority carries out an examination of the documents and the object of the activity of the license applicant.

An expert examination at the place of medical activity begins with an organizational meeting, at which the commission gets acquainted with the head (individual entrepreneur), the structure of the institution, its performance indicators, the dynamics of material and technical development - in cases of re-licensing. After that, the order and conditions of work are determined.

Experts are freely provided with the necessary information and documents within their competence.

The head of the medical facility provides each expert with the requested information, documents for the optimal and objective solution of the problem.

On site, the expert(s) evaluate(s) the resource requirements:

real estate (sanitary and technical condition, recruitment and space, rationality of functional purpose, flow of personnel and patients for compliance with SNiP 2.0802-89, SanPiN 2.1.3.1375-03 - the requirements are specified in standardized forms for each type of work and service developed by the Ministry of Health of the Moscow Region) ;

equipment (sufficiency of equipment - the requirements are specified in standardized forms for each type of work and service developed by the Ministry of Health of the Moscow Region, condition, operating conditions, safety conditions, modernity of medical equipment, instruments, medical furniture, soft inventory, furniture for compliance with the equipment list, the State Register of Medical products, to the order of the Ministry of Health of the USSR dated 03.10.1990 No. 394 "On approval of the regulation on the comprehensive maintenance, repair, installation and adjustment of medical equipment", order of the Ministry of Health and Medical Industry of Russia dated 04.10.1995 No. 276 "On measures to strengthen the metrological service of the Ministry of Health and Medical Industry of Russia");

storage and use of medicines, consumables;

qualifications of personnel (orders of the Ministry of Health of Russia dated 08.27.1999 No. 337 "On the nomenclature of specialties in healthcare institutions of the Russian Federation"; dated 08.19.1997 No. 249 "On the nomenclature of specialties of nursing and pharmaceutical personnel"; dated 05.06.1998 No. 186 "On advanced training specialists with secondary medical and pharmaceutical education"; orders of the Ministry of Health of the USSR dated 07.21.1988 No. 579 "On approval of the qualification characteristics of medical specialists"; dated 01.20.1982 "On measures to further improve the training of medical personnel in internship" in the current editions).

Organizational conditions are assessed on site:

occupational health and safety for compliance with the Federal Law of July 17, 1999 No. 181-FZ "On the basics of labor protection in the Russian Federation";

safety of use of resources (electrical, fire, biological, radiation, X-ray, explosion safety and other safety from physical, chemical and biological factors for compliance with the Safety Rules for the operation of medical equipment in healthcare facilities. General requirements, approved Ministry of Health of the USSR on August 27, 1984);

operation and life support of resources (energy, heat, water supply, communications, including autonomous sources);

provision of normative and methodological material and organization of methodological work;

providing accounting and reporting documentation (Order of the Ministry of Health of the USSR dated 04.10.1980 No. 1030 "On approval of the forms of primary medical documentation of healthcare institutions", as amended and supplemented);

continuity of the treatment and diagnostic process and the provision of additional treatment and rehabilitation assistance (concluding agreements with third-party organizations, if necessary), which are an indicator of the organizational and technical capabilities of the applicant;

intradepartmental quality control (Order of the Ministry of Health of Russia No. 363 and FFOMS No. 77 of October 24, 1996 "On improving the quality control of medical care for the population of the Russian Federation");

personnel management.

Based on the results of the check, the members of the commission fill out an expert opinion in the prescribed form, which indicates the checked types of work and services, their generalized characteristics for each section or object, and surrenders to the senior expert.

The Chairman of the Commission is responsible for the completeness and quality of the expert examination, the correctness of filling out the expert opinions. He also summarizes the preliminary results of the examination and informs the license applicant about them.

The expert who conducted the examination of the documents fills in the conclusion form on the compliance of the license applicant with the license requirements and conditions for the documents.

The expert who performed the examination at the place where medical activities are carried out fills out a form of conclusion on the compliance of the license applicant with license requirements and conditions with a visit to the place where this activity is carried out.

The head of the subdivision of the expert institution draws up a conclusion, which summarizes the expert opinions of the commission's experts.

The decision of the commission for licensing medical activities is documented in a protocol and serves as the basis for issuing an order of Roszdravnadzor to issue a license (refusal to issue a license, suspend the license).

Licensing requirements and conditions for the implementation of medical activities are:

a) the applicant for a license (licensee) has the relevant premises belonging to him on the right of ownership or on another legal basis;

b) the availability of appropriate organizational and technical conditions and material and technical equipment, including equipment, tools, transport and documentation, ensuring the use of medical technologies approved for use by Roszdravnadzor;

c) the availability and maintenance of fire protection equipment (fire alarm and fire extinguishing), fire water supply and the estimated stock of special equipment necessary for extinguishing a fire, as well as the availability of a personnel action plan in case of fire;

d) the presence in the staff of employees (doctors, paramedical personnel, engineering and technical workers, etc.) with higher or secondary specialized, additional education and special training corresponding to the requirements and nature of the work performed and the services provided, as well as the fact that the head of the licensee and (or) the person authorized by him has higher specialized education and work experience in the licensed activity (for specific types of work and services) for at least five years - for a legal entity;

e) the presence of higher or secondary medical education, additional education and special training that meet the requirements and nature of the work performed and the services provided, and at least two years of work experience in the licensed activity - for an individual entrepreneur;

f) improving the qualifications of employees engaged in medical activities at least once every five years - for a legal entity, as well as for an individual entrepreneur.

To obtain a license, the license applicant submits the following documents to the licensing authority:

a) an application for a license, indicating:

1) full and (if available) abbreviated name, including company name, organizational and legal form, location (legal and actual address with index), which must comply with the constituent documents and the certificate of state registration of the legal entity ;

2) addresses of places where the licensed type of activity is carried out (locations of separate subdivisions of the legal entity and facilities used to carry out the licensed activity), which must comply with the constituent documents; the fact that a legal entity has branches and (or) representative offices must be recorded in the constituent documents;

3) the state registration number of the entry on the creation of a legal entity and the data of the document confirming the fact of entering information about the legal entity in the Unified State Register of Legal Entities;

4) licensed activities that a legal entity or an individual entrepreneur intends to carry out (with a list of works and services);

b) copies constituent documents and a document confirming the fact of making an entry about legal entity to the Unified State Register of Legal Entities, indicating its code according to the All-Russian Classifier of Enterprises and Organizations;

a copy of the certificate of state registration of the license applicant as an individual entrepreneur;

c) a copy of the sanitary and epidemiological conclusion on the compliance with the sanitary rules of the work performed and the services provided that make up the medical activity;

d) a copy of the certificate of registration of the license applicant with the tax authority;

e) a document confirming the payment of the license fee for consideration by the licensing authority of an application for a license;

f) copies of documents confirming the qualification of an individual entrepreneur or employees of a legal entity that meets the licensing requirements and conditions.

Documents submitted for obtaining a license are accepted according to the inventory, a copy of which, indicating the date of their acceptance, is sent (delivered) to the license applicant by the licensing authority.

Copies of documents not certified by a notary shall be submitted with the presentation of the original.

It is not allowed to require a license applicant to submit documents that are not provided for by these Regulations.

For the provision of false or distorted information, the license applicant is liable in accordance with the legislation of the Russian Federation.

When conducting licensing, the licensing body has the right to check the compliance of the license applicant with the licensing requirements and conditions.

The licensing authority makes a decision to grant or refuse to grant a license within 60 days from the date of receipt of the application with all necessary documents.

The licensing authority is obliged within five days from the date of the decision to grant, extend the validity period, reissue, suspend, renew or cancel the license to notify (in writing) the licensee, as well as the relevant authorities tax service and health authorities.

The licensee is obliged to notify the licensing authority within 15 days (in writing) of a change in its location, as well as the location of territorially separate subdivisions and facilities used to carry out the licensed activity. Notification by fax is not allowed.

A licensee carrying out activities on the basis of a license granted to him by the licensing authority of a constituent entity of the Russian Federation may conduct this activity on the territory of other constituent entities of the Russian Federation, subject to prior notice to the relevant licensing authorities in the prescribed manner.

The term of validity of the license to carry out medical activities is 5 years.

In case of loss of the license, the licensee has the right to obtain its duplicate.

If the licensee has territorially separate subdivisions and facilities used to carry out the licensed activity, copies of it certified by the licensing authority according to the number of specified subdivisions and facilities shall be issued simultaneously with the license.

Control over compliance by the licensee with the license requirements and conditions is carried out on the basis of an order of the licensing authority, which determines the licensee, the composition of the commission that carries out the verification, and the period for its implementation.

The duration of the verification should not exceed 15 days.

A scheduled inspection is carried out no more than once every 2 years.

An unscheduled inspection is carried out to confirm that the licensee has eliminated the violations of license requirements and conditions identified during the scheduled inspection, as well as if the licensing authority receives information about the existence of such violations.

Certification medical workers

The certificate confirms the certification of a specialist. It is issued on the basis of postgraduate professional education (internship, clinical internship, postgraduate study), as well as doctors with experience - additional education in courses and faculties of improvement; qualification followed by a verification test.

As you know, a certificate is issued for the declared types of activities (and in this it is similar to a license) for certain types of medical or pharmaceutical activities in accordance with the Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens. This is noted in the letter of the Ministry of Health of Russia "On the clarification of the order of the Ministry of Health of Russia or 07.08.95 No. 15-00 "On approval of the Regulations on the procedure for admission to the implementation of professional (medical or pharmaceutical) activities."

The procedure for admission to the implementation of medical activities is set out in a number of documents. These include the Regulations on the final state certification of graduates of higher educational institutions in the Russian Federation, approved. Decree of the State Committee of the Russian Federation for Higher Education dated May 25, 1994 No. 3, Order of the Ministry of Health of Russia dated March 31, 1997 No. 3 "On the phased introduction since 1997 of the final state certification of graduates of higher medical and pharmaceutical educational institutions", as well as a letter from the Ministry of Health of Russia dated June 15 .00 No. 2510-6646 "On the final state certification of graduates of higher medical and pharmaceutical educational institutions."

The mentioned letter gives the stages of attestation, the list and form of examinations and, importantly, qualification characteristics, a list of knowledge and skills for graduate doctors in the following specialties: "General Medicine" (040100), "Pediatrics" (040200), "medical and preventive care "(040300), compiled on the basis of the state standard.

After passing the mandatory primary one-year postgraduate training (internship), the doctor must prove that his professional education complies with the state standard, the official certificate of which is a specialist certificate. For higher medical education, the State Standards were approved by the State Committee for Higher Education of Russia on the basis of Decree of the Government of the Russian Federation of August 12, 1994 No. 940 "On Approval of the State Educational Standard of Higher Professional Education" in accordance with standard plans and programs reviewed every 5 years.

According to Art. 60 "Doctor's Oath" of the Basic Laws of the Russian Federation on the protection of the health of citizens, persons who have graduated from higher medical educational institutions in Russia take an oath before receiving a doctor's diploma. In Federal Law No. 214-FZ of 20.12.99 "On Amendments to Article 60 of the Fundamentals of Legislation of the Russian Federation on the Protection of Citizens' Health", for the first time after the adoption of the new Constitution of the Russian Federation, the text that is given above was published.

Doctors for violation of the doctor's oath are liable under the legislation of the Russian Federation.

Certification of doctors, pharmacists, and other specialists with higher education is carried out in accordance with the order of the Ministry of Health and Medical Industry of Russia dated February 16, 1995 No. 33 "On approval of the Regulations on the certification of doctors, pharmacists and other specialists with higher education in the healthcare system of the Russian Federation" (as amended on September 28. 99) and the order of the regional health department, which form the composition of the certification commission. The commission is headed by the chairman, he determines the rules of its work (Appendix 1 to the mentioned order). The commission consists of a secretary and members from among highly qualified specialists, scientists and medical practitioners. The form of work of the commission is meetings held according to the schedule approved by the head of the health management body. Members of the commission get acquainted with the submitted materials 10 days before the meeting. The decision is taken by open voting by an absolute majority of votes and is valid throughout Russia. The chairman of the profile subcommittee takes part in the meeting of the commission.

The second category is assigned to doctors who have at least 5 years of experience in this specialty, the first - at least 7, the highest - at least 10 years. Work experience includes training in internship, clinical residency and postgraduate studies in the same specialty. In some cases, with high practical and theoretical training, a higher category can be assigned without established requirements for length of service. Specialists with the degree of Doctor of Medical Sciences, the highest category is assigned in absentia. In case of refusal of a specialist from the next recertification, the previously assigned category is lost. Attestation is carried out for a fee at the expense of the assessed person, trade union, scientific society or association at officially established rates.

The development of medical science, the ever-increasing volume of information, the deepening of the differentiation and specialization of medical care for the population make it necessary to regularly improve the level of professional knowledge of medical workers. After graduating from an educational institution, the professional development of a medical worker continues throughout life. The main task, according to the definition adopted by WHO back in 1980, is the continuous improvement of the competence of medical personnel in their daily work.

Continuing education is a process designed to help healthcare professionals adapt to changes in medical science and practice, as well as in healthcare management. Continuing medical education should provide additional knowledge at any stage medical training. At the same time, the volume and degree of assimilated material depend primarily on the level of professional training of a specialist. It is on this basis that it is necessary to build continuous improvement on state level; it is important to take into account the needs of society and the health system, which is especially important in a period of reform.

The ultimate goal of continuing medical education is continuous improvement quality of preventive and curative care.

Continuing education of primary health care workers is of paramount importance. According to WHO experts, lifelong education models should be reoriented in this way.

The previously existing system of postgraduate professional education and certification of medical and pharmaceutical personnel was focused on narrow specialization. Today, the demands of healthcare practice dictate the need to revive the experience gained in the history of medical education in our country, to use the positive experience of educational institutions of foreign countries in the comprehensive training, retraining and advanced training of medical workers.

There is currently a large number of types of postgraduate training of doctors. All these training options are constantly being modified, improved, and undergo changes due to the fact that the system of postgraduate education is very dynamic and developing. The system of postgraduate professional education includes 7 educational institutions (academies and institutes) for the improvement of doctors and more than 40 faculties at medical universities. In addition, doctors receive postgraduate professional education at medical research institutes, scientific centers and associations, if the latter have a license to conduct educational activities. The system of additional vocational training for workers with secondary medical and pharmaceutical education is represented by 41 advanced training schools.

The dynamics of changes in the number of students at institutes and faculties of postgraduate education was characterized by an increase in the number of students from 56,000 in 1975 to 141,000 in 1993, and the proportion of students who were trained on the basis of advanced medical faculties increased during this time from 17% to 43% . At the same time, according to a number of experts, it is advisable to change the current structure of educational institutions of additional education, which includes both independent academies and institutes of postgraduate education, and a network of faculties for the improvement of doctors in medical universities. The future here belongs to the faculties of universities. This is evidenced by the recent trend towards an increase in the number of students at the faculties of advanced training of doctors and a certain decrease in their number in academies and institutes of postgraduate education.

The main documents regulating the procedure for postgraduate training of doctors are the “Regulations on the qualification exam for obtaining a specialist certificate”, approved by the Order of the Ministry of Health of the Russian Federation dated November 17, 1995 No. 318, and the Order of the Ministry of Health of the Russian Federation dated August 27, 1999 No. 337 “On the nomenclature of specialties in healthcare institutions of the Russian Federation”. They provide for such innovations as mandatory certification of medical specialists, a new nomenclature of medical specialties, including 70 specialties, and the approval of an educational qualification for each specific medical specialty, i.e. the minimum level of postgraduate training required for the admission of a doctor to independent work in his chosen field of medicine.

In accordance with the current normative documents in Russia, persons who have received higher and/or secondary vocational education and who have a specialist diploma and certificate are allowed to engage in medical and (or) pharmaceutical activities. Diploma - a document on the level of education, specialty, training and qualifications issued by an educational institution of vocational education of various organizational and legal forms, which has a license for the right to conduct educational activities issued by government agency administration of education or, on his behalf, the local authority of education at the location educational institution based on the opinion of the expert committee.

After graduating from a medical university, a graduate must pass one of the following forms of training in the system of postgraduate professional education:

1) internship (1 year);

2) residency (2-3 years),

3) educational and professional program in the specialty (courses or cycles of improvement with the passing of a certification exam, 1-4 years);

4) postgraduate studies (3 years).

Graduates of medical schools undergo further training in the following order.

For most major medical specialties (about 25) and all dental specialties, the minimum level of postgraduate training is internship. In accordance with the “Regulations on internships”, this type of training should be carried out in large public medical institutions approved by local authorities health care management as bases for the training of interns in this specialty.

The duration of the internship is 11 months. The purpose of training in an internship is to acquire in full the systematized theoretical knowledge and the necessary professional practical skills to perform work as a doctor. During the internship, interns pass two certifications at the specialized department of the university that supervises the training young specialist and at the end of their studies they have the right to pass a qualifying examination to obtain a certificate of a specialist in this specialty.

Specialist certificate is a single sample document confirming the compliance of specialist training with state educational standards. The certificate indicates that a specialist has achieved a certain level of theoretical knowledge, practical skills and abilities sufficient for independent professional (medical or pharmaceutical) activities.

The certificate of a specialist is issued by state medical educational and research institutions that carry out postgraduate training of specialists.

At these institutions, examination qualification commissions are created, which conduct verification tests (examinations) of the certificate applicant.

To obtain a certificate, a specialist must submit the following documents to the examination committee:

1. Application.

2. A copy of the diploma of graduation from a medical or pharmaceutical educational institution (faculty).

3. A copy of the diploma or certificate of advanced training and specialty.

4. A copy of the researcher qualification diploma after completing the postgraduate course.

5. Copies of diplomas of the candidate (doctor) of medical (pharmaceutical) sciences and academic title (senior Researcher, assistant professor, professor).

6. Copies of previously issued certificates.

7. Service record (extract from the work book).

Those who successfully pass the exam will receive a certificate..

To obtain the right to work independently in the main specialty, an internship is a sufficient minimum level of postgraduate education. However, if a doctor wants to master one of the specialties that require in-depth training, then he must undergo a two-stage training: Stage I - internship (or clinical residency, postgraduate study) in the main specialty, Stage II - professional retraining (primary specialization), clinical residency or postgraduate study in the chosen specialty.

The sequence and correspondence of the basic and narrow specialties are strictly regulated: for example, in-depth training in the specialty "nephrology" must be preceded by training in an internship in the specialty "therapy"; primary specialization in the specialty "coloproctology" can be taken by doctors who have successfully completed the first stage of training in the specialty "surgery", etc. Graduates of dental faculties can be trained in narrow dental specialties (therapeutic, surgical, orthopedic or pediatric dentistry, orthodontics) only after receiving a certificate in the specialty "dentistry".

For most specialties requiring in-depth training, the minimum course of study at the second stage is professional retraining, i.e. primary specialization. The duration of such a course of study is at least 500 hours of study (depending on the specialty - from 3.5 to 6 months or more). Professional retraining of specialists has the right to be carried out only by state educational institutions that have a license to conduct postgraduate training in this specialty.

For some specialties (for example, cardiovascular surgery, maxillofacial surgery), the minimum level of training at the second stage of training is clinical residency, and therefore the duration of postgraduate training for these specialists is currently at least 3 years: 1 year in an internship in main specialty and 2 years in clinical residency in a narrow specialty. Since 2000, this sequence of postgraduate training in a number of specialties has been mandatory.

Doctors who have successfully completed the II stage of training are entitled to receive a second certificate in the specialty corresponding to the training profile at this stage. At the same time, each of the specialties included in the nomenclature requires a separate course of study. Simultaneous obtaining of certificates in several specialties (even close ones, for example, "endocrinology" and "diabetology") is not provided for by the current regulatory documents.

The certificate of a specialist gives the doctor the right to work independently in his specialty. Once every five years, all doctors must complete medium-term cycles of thematic improvement (duration of at least 144 academic hours) and re-take an exam to confirm the certificate of a specialist in any licensed state university in the Russian Federation.

Issues of specialization and improvement are closely related to the certification and attestation of medical and pharmaceutical personnel. Certification of medical and pharmaceutical personnel was provided for by Art. 54 "Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens" and introduced in the industry by order of the Ministry of Health and Medical Industry of Russia No. 286 dated 12/19/94.

In connection with the publication of the Decree of the Ministry of Labor of the Russian Federation and the State Committee of the Russian Federation for Standardization, Metrology and Certification No. 21/9 dated 04.20.97 "On the development of a certification system for personnel in the Russian Federation", the Ministry of Health of Russia, together with the Ministry of Labor of the Russian Federation, resolves issues of improving and developing the system of certification of medical and pharmaceutical workers.

In accordance with Art. 63 of the Fundamentals of the Legislation of the Russian Federation on the Protection of the Health of Citizens, an inalienable right of medical and pharmaceutical workers is "obtaining qualification categories in accordance with the level of theoretical and practical training received."

For this purpose, the system of certification of specialists for the corresponding qualification category has been successfully functioning in the healthcare system of Russia for many years.

Certification doctors and paramedical workers is milestone in improving the professional level of health workers and is aimed at increasing professional responsibility for the performance of their functional duties.

Organization attestation work is considered as one of the mechanisms of state control over the placement and use of medical personnel, the level and quality of medical care to the population.

Certification is carried out at the request of a specialist and is voluntary.

To certification for the qualification category are allowed:

Persons with higher and secondary medical and pharmaceutical education and who have received the right to engage in medical and pharmaceutical activities in healthcare institutions, regardless of ownership;

Persons with a higher non-medical education, admitted in the prescribed manner to medical activities and holding medical and pharmacist positions in healthcare institutions;

Epidemiologists, biologists, zoologists, entomologists working in healthcare institutions in their respective positions (with the participation of specialists in these profiles in the work of the commission).

In accordance with the order of the Ministry of Health of the Russian Federation No. 314 dated August 9, 2001 “On the procedure for obtaining qualification categories”, the procedure for obtaining qualification categories by specialists is determined, as well as the structure and main functions attestation commissions.

When obtaining a qualification category, professional qualifications, competence, as well as the ability to perform official duties in accordance with the position held are assessed. The qualification of a specialist is determined by three qualification categories: second, first and highest.

A specialist can receive a qualification category in specialties corresponding to both the main and combined positions. The qualification category is valid for five years from the date of issuance of the order on its assignment.

Specialists who have expressed a desire to obtain a qualification category submit to the certification commission an application, a completed certification sheet and a report on work for the last three years - for specialists with higher professional education and for the last year - for employees with secondary professional education, approved by the head of the organization in which specialist works. Three months before the expiration of the qualification category, a specialist can submit an application to the certification commission to confirm the existing qualification category or obtain a higher one.

The specialist has the right:

Get a qualification category in the attestation commission.

Familiarize yourself with the documents submitted to him "to the attestation commission.

Obtain written explanations from the manager in case the manager refuses to sign the work report.

Undergo professional development.

Apply with an application to the Central Attestation Commission or the body under which the Attestation Commission was created, in case of disagreement with the decision of the Attestation Commission.

In order to exercise the right to receive a qualification category, attestation commissions are created:

Central Attestation Commission - Ministry of Health of the Russian Federation.

Attestation commissions - by the health authorities of the constituent entities of the Russian Federation, centers of state sanitary and epidemiological surveillance in the constituent entities of the Russian Federation, the Federal Directorate of Biomedical and Extreme Problems under the Ministry of Health of the Russian Federation.

Attestation commissions in healthcare institutions, scientific and educational medical institutions - by the Ministry of Health of the Russian Federation, other ministries and departments according to their subordination.

Certifying commission:

Determines the order, procedures and methods of work of the commission.

Involves independent experts to give opinions on reports on work.

Considers the submitted documents within two months from the date of their receipt (registration).

Makes decisions on the assignment, confirmation or withdrawal of qualification categories.

Issues a certificate standard pattern and, if necessary, an extract from the order on obtaining a qualification category.

Conducts business.

Assessment of qualifications and recommendations for further vocational training specialist are accepted by voting in the presence of at least 2/3 of the number of members of the approved composition of the attestation commission. The results are determined by a majority vote of the members present.

The body under which the attestation commission is established, within one month, issues an order on the assignment of a qualification category, which is brought to the attention of the specialist and the head of the healthcare institution.

When assigning a qualification category, it is recommended to follow the sequence of category assignment (second, first, highest).

In some cases, a specialist, taking into account his high theoretical and practical training in the chosen specialty, good performance in work, can be assigned a higher qualification category without established requirements for work experience.

Specialists who have the degree of Doctor of Medical Sciences and are employed in medical and preventive work in healthcare institutions, research and educational institutions are assigned the highest qualification category in the relevant specialty in absentia based on the presentation of the head of the institution where the Doctor of Science works.

Specialists who, based on the results of certification (re-certification), have been assigned a qualification category, are issued a certificate of the established form.

Recertification to confirm the existing qualification category is carried out every five years without fail.

In case of refusal of a specialist from the next recertification, the qualification category assigned earlier is lost from the moment of the expiration of the five-year term for its assignment.

In recent years, the interest of specialists in obtaining a qualification category has sharply increased. In order to improve the certification system for the assignment of qualification categories, for the first time, a nomenclature of specialties for nursing and pharmaceutical personnel and a list of correspondence of specialties to positions were developed and approved. Qualification characteristics and regulations on specialists were developed in accordance with the nomenclature (for 26 specialties), which made it possible to streamline and unify the work of attestation commissions, establish firm regulations that promote the rational use and placement of middle-level personnel.

The qualification characteristics and positions of medical specialists are being reviewed. Currently, the nomenclature of medical specialties includes 70 specialties. Over the past decade, new specialties have been introduced: diabetology, general practice (family medicine), allergology and immunology, geriatrics, maxillofacial surgery, audiology - otorhinolaryngology, transfusiology, clinical pharmacology and pediatric oncology.

New learning programs, qualification characteristics of specialists are being developed, compliance with which should be a criterion for issuing appropriate certificates to doctors. To unify the certification examination procedure, a bank of test items for each specialty has been created.

Particular attention is paid to certification (certification) cycles for professionals with experience practical work and medical categories. These cycles last at least 2 months. are organized mainly in universities at the faculties of postgraduate professional education. They can be conducted in the form of intermittent full-time and part-time face-to-face cycles. Curricula should be drawn up taking into account the requirements for each qualification category. In the certification process Active participation should be received by representatives of health authorities and medical associations.

Another important problem is re-certification - the certification of specialists with the highest certification category. For this group of doctors, criteria can be proposed to confirm their active work to improve professional excellence: participation in congresses and congresses, publications, teaching and research work, etc. It is also possible to organize special three-four-week improvement cycles.